1. Technical Field
The subject application relates to a surgical apparatus for fragmenting and removing tissue or bodily organ parts during surgery, and is particularly adapted to use during endoscopic surgical procedures.
2. Background of Related Art
One of the recent advances in the surgical area has been endoscopic surgery which in many cases reduces the invasiveness of a surgical procedure and overall patient trauma. Generally, endoscopic surgery involves incising through body walls for examining, viewing and/or operating on various bodily organs or structures, including the ovaries, uterus, gall bladder, bowels, kidneys, appendix, etc. In endoscopic procedures, a trocar typically creates an incision and trocar tubes or cannula devices are extended into and left in place in the abdominal wall so that endoscopic surgical tools may be inserted through the trocar cannula. A camera or endoscope is inserted through the trocar cannula which, is generally located at the navel incision, thereby enabling the visual inspection and magnification of a cavity in the body. The surgeon then performs the desired procedure at the surgical site with the aid of specialized instrumentation designed to fit through additional trocar cannulas which provide additional entries into the desired body cavity. Thus, instead of a rather large incision (typically 12 inches or larger) necessary to complete a fully invasive surgical procedure, endoscopic surgery results in several smaller incisions, usually between 5 and 15 millimeters in size. In most instances, recovery is quicker and less painful than traditional surgery. In addition, because the surgical field is greatly magnified surgeons are often better able to dissect blood vessels and control blood loss. In addition, heat and water loss are often reduced as a result of the smaller incisions.
In many surgical procedures, it is often necessary to remove tissue or diseased organs. This is especially challenging during endoscopic surgery because the tissue or organ removal must be achieved through the small openings through which the procedure is performed. In these situations it may be desirable to fragment, or morcellate, or cut into smaller segments the bodily tissue so that it can be readily removed through the small endoscopic openings.
Morcellation involves fragmenting and removing diseased tissue or organ parts from healthy tissue or organs. In endoscopic morcellation, the fragmented pieces are typically removed from the patient's body through a small incision or through a trocar cannula device which extends through the abdominal wall. When the tissue or organ part is diseased or infected, it is preferred that the excised portions thereof be isolated from contact with surrounding healthy tissue. Accordingly, it is often necessary to enclose the fragmented organ during removal, thus preventing contamination of healthy tissue and bodily organs. A device for accomplishing such a task is disclosed in U.S. Pat. No. 4,428,375 which describes a drawstring bag for encapsulating a fragmented organ during surgical repair. In some instances, the organ is fragmented in the bag by a surgical device known as a morcellator, until such a time as the entire specimen is small enough to be removed while in the bag, from the abdominal cavity, via the trocar cannula.
Once the diseased tissue or organ has been fragmented and removed from the body cavity, it is often necessary to reconstruct the fragmented tissue pieces into their original orientation for pathologic evaluation. A subsequent examination of the reconstructed tissue enables, and is often necessary for, a precise diagnosis of the patient's ailment. However, to facilitate the reconstruction of the tissue part, the fragmented tissue pieces must be of a suitable size and shape.
Generally, there are two types of endoscopic morcellators, manually operated and electrically assisted. Manually operated morcellators are typically operated by a hand lever connected to an elongated endoscopic member. The distal end of the endoscopic member is connected to cutting members which are operatively associated through the endoscopic member with the hand lever. In use, the manually operated morcellator is advanced to the surgical site where the tissue or bodily organ part to be separated is positioned between the cutting members. The surgeon then actuates the cutting members to cut the tissue or organ part. If the removal of the tissue or organ is being performed without a surgical bag, the surgeon must repeatedly remove the morcellator completely from the abdominal cavity to remove the fragmented tissue or bodily organ part from the cutting member and then reinsert the morcellator, via the trocar cannula, back to the surgical site to remove a further tissue or organ part. If the removed tissue or organ is diseased or infected, it may be necessary to place the organ in a surgical bag prior to fragmentation and removal. When the surgical bag is employed, the cutting edges of the morcellator cannot cut the surgical bag because such would result in tearing the bag and potentially exposing diseased tissue to healthy body tissue.
Electric morcellators are generally used in conjunction with a surgical bag and are typically provided with a high speed cutting blade that rapidly fragments the tissue or organ into very small pieces within the bag to enhance removability. The fragmented tissue or organ can then be aspirated from the bag, or the entire bag may be removed containing the fragmented tissue. One such electric morcellator is described in U.S. Pat. No. 5,215,521 to Cochran et at.
Such electric morcellators may disadvantageously result in the rotating cutting blade cutting the surgical bag, thus risking the possibility that healthy tissue surrounding the surgical bag may become contaminated by the resulting leakage. Additionally, the tissue or organ parts which are fragmented by the electric morcellator may be insufficiently sized to undergo a proper pathologic evaluation.
Thus, there exists a need for an endoscopic morcellator which is easy to operate, capable of aiding in the removal of diseased tissue without infecting surrounding healthy tissue, and which fragments tissue in manner which allows the pieces to be of a sufficient size to undergo a proper pathologic evaluation.